Vaginal ectopic ureter diagnosed by magnetic resonance imaging in a child with complete transverse vaginal septum and hydrocolpos

Ectopic ureter draining into the vagina is a rare cause of urinary incontinence. Some cases have been reported in association with malformations of the genitourinary tract, but very few published cases are associated with vaginal septum. Our article describes the case of a girl who presented with hydrocolpos shortly after birth and was found to have a complete transverse vaginal septum. Despite successful correction of this genital anomaly, the patient developed persistent dribbling of clear fluid from the genital area. Extensive testing revealed unilateral kidney dysplasia and probable genital ectopia of the corresponding ureter. Magnetic resonance imaging (MRI) showed insertion of the ureter into the upper third of the vagina. The patient underwent nephroureterectomy of the dysplastic kidney with subsequent improvement in urinary incontinence. Ureteral ectopia is difficult to diagnose with conventional imaging methods (plain radiography, ultrasound, and CT). MRI has proved to be an excellent method for assessment of genitourinary tract conditions, particularly when other diagnostic modalities have failed or are limited, due to the high resolution of MRI scans and the possibility of native image acquisition on all three orthogonal planes. MRI is the best diagnostic modality for visualization of the course and insertion of ectopic ureters, and enables precise surgical correction

Development of a risk score for earlier diagnosis of chronic kidney disease in children

Objective To develop a clinical score for the early identification of chronic kidney disease (CKD) in children and adolescents. The early diagnosis of CKD in childhood allows the adoption of measures to slow the progression of the disease, thereby reducing morbidity and mortality. Nevertheless, the diagnosis is often made too late for proper patient management. Study design We preformed a case-control study of a multicenter Brazilian sample of 752 pediatric patients; the study cases (n = 376) were CKD patients with a median estimated GFR of 37 (IQR = 22 to 57) ml/min/1.73 m(2). The control group (n = 376) comprised age-, gender-and center-matched children who were followed for nonrenal diseases. Potential risk factors were investigated through a standard questionnaire that included symptoms, medical history, and a clinical examination. Two multivariable models (A and B) were fitted to assess predictors of the diagnosis of CKD. Results In model A, 9 variables were associated with CKD diagnosis: antenatal ultrasound with urinary malformation, recurrent urinary tract infection, polyuria, abnormal urine stream, nocturia, growth curve flattening, history of hypertension, foamy urine and edema (c-statistic = 0.938). Model B had the same variables as model A, except for the addition of the history of admission during the neonatal period and the exclusion of antenatal ultrasound variables (c-statistic = 0.927). Conclusions The present scores may serve as a warning sign for CKD diagnosis in children among professionals working in the primary care setting where the symptoms associated with a risk of CKD may be overlooked14

Prostaglandina E2 urinária e calciúria em crianças agudamente imobilizadas

A imobilização pode resultar em hipercalciuria, hipercalcemia e desmineralização óssea. A magnitude de perda óssea varia de acordo com a idade, a extensão e o tempo de imobilização. Crianças imobilizadas por longos periodos apresentam hipercalciuria, hiperfosfaturia, déficit na capacidade de concentração urinaria, nefrocalcinose e/ou urolitíase. A patogênese desses achados ainda persiste controversa. A prostaglandina E2 (PGE2) tem sido apontada como um dos fatores responsaveis pela perda do conteudo mineral ósseo induzida pela imobilização. No rim, as prostaglandinas têm influência na reabsorção de água, sódio e calcio. O aumento de atividade da PGE2 e sua associação com hipercalciuria relacionada à imobilização em crianças nunca foram estudados. Avaliamos 15 crianças previamente hígidas, que foram imobilizadas agudamente após procedimento ortopédico, durante 3 periodos seqüenciais: (A) nos primeiros 3 dias de imobilização; (8) após o 4° dia de imobilização, na presença de hipercalciuria; (C) durante 3 dias de uso de indometacina (3 mg/kg/dia), na presença de hipercalciuria. As variáveis estudadas foram: PGE2 urinária como índice de síntese renal; PGE-M, metabólito da PGE2, como índice de produção sistêmica; calciuria; excreção fracionada de sódio; osmolalidade urinária maxima; creatinina sérica; calcemia e potassio sérico. Os valores de PGE2, PGE-M e calciuria representam a excreção urinaria em relação a creatinina, em amostra urinaria de jejum. A mediana da concentração sérica de creatinina foi normal em todos os periodos e não se modificou durante o estudo. Hipercalcemia (calcio sérico > 10,5 mg/dl) ocorreu em um paciente no periodo A e em 4 outros durante o estudo. Houve um aumento significativo da excreção fracionada de sódio durante a imobilização, que não diminuiu significativamente durante o uso de indometacina, embora nesse momento tenha havido uma correlação significativa com os niveis de PGE,. Desde o momento basal, a mediana dos niveis de osmolalidade urinaria de jejum foi inferior a 800 mOsm/1 e não variou significativamente durante o estudo mesmo com uso de desmopressina nasal. Todos os pacientes desenvolveram hipercalciúria (calcio/creatinina urinarias > 0,2) durante o periodo B (mediana de 0,29; amplitude de 0,21 a 1,00); 6 das 15 crianças tornaram-se normocalciúricas no periodo C. Entretanto esta diminuição não foi estatisticamente significativa. A excreção urinaria de PGE, aumentou significativamente de 0,06 ng/mg (amplitude de 0,01 a 0,45) no periodo A, para 0,21 ng/mg (amplitude de 0,02 a 1,93) no periodo B, diminuindo significativamente após o uso de indometacina. A excreção urinaria de PGE-M aumentou significativamente de 0,3 ng /mg (amplitude de 0,03 a 13,50) no periodo A, para 14,96 ng/mg (amplitude de 0,26 a 25) no periodo B, diminuindo após o uso de indometacina para 7,88 (amplitude de 0,77 a 20,70), mas não significativamente. Entretanto os niveis de PGE, e PGE-M não se relacionaram significativamente com a calciúria nos 3 periodos do estudo. Houve marcado estimulo das PGE, renal e sistêmica, hipercalciúria e aumento da excreção fracionada de sódio em razão da imobilização, embora esses dados não tenham tido poder de demonstrar uma relação causal direta entre PGE, e PGE-M urinarias e calciúria.Prolonged immobilizalion is known lo resull in hypercalciuria, hypercalcemia and reduclion in skelelal mass. The magnilude of bone loss varies wilh subject age and lhe extenl of immobilizalion. Children who are immobilized for long periods of lime have hypercalciuria, hyperphosphaluria, decreased urinary concenlralion capacily, nephrocalcinosis and/or urolilhiasis. The palhogenesis of hypercalciuria, hypercalcemia and osleoporosis encounlered in immobilized subjects remains conlroversial. The relalionship belween increased renal proslaglandin E2 (PGE2) activily and lhe hypercalciuria associaled wilh immobilizalion in children had nol been previously sludied. Urinary PGE2 leveis, as an index of renal PGE2 synlhesis, urinary leveis of proslaglandin EM (PGE-M), as an index of syslemic PGE2 synlhesis, urinary calcium excrelion, fractional excrelion of sodium, maximal urinary osmolalily, senum crealinine, calcemia and senum polassium were sludied in 15 olherwise heallhy children , who were immobilized following orthopedic procedures, during 3 sequenlial periods: (A) on lhe firsl 3 days of immobilizalion; (8) after 4 days of immobilizalion, in lhe presence of hypercalciuria (Uca/Ucr > 0.2 mg/mg); (C) after 3 days of indomelhacin Iherapy during hypercalciuria. The median of senum crealinine concenlralion was nonmal in ali periods of lhe sludy. Hypercalcemia (serum calcium > 10.5 mg/dl) occurred in one palienl (10.7 mg/dl) during period (A) and in 4 olher palienls during lhe sludy. There was a significanl increase in lhe fraclional excrelion of sodium during immobilizalion, bul il didn'l decrease wilh indomelhacin, eventhough there was a signilicant correlation with urinary PGE2 in this period. 46% 01 maximal urinary osmolality leveis were less than 800 mOsm/1 during period A and didn't vary signilicantly even with inlranasal desmopressin. Ali palienls developed hypercalciuria (Uca/Ucr, median 01 0.29 ; range 0.21 to 1.00) during period (B); 6/15 children became norrnocalciuric during period C, bul lhe decrease was not signilicant. Urinary PGE2 increased Irom 0.06 ng/mg (range 0.01 to 0.45) during period A, to 0.21 ng/mg (range 0.02 lo 1.93) during period B, decreasing during lhe use 01 indomelhacin (p < 0,05). Urinary PGE-M increased signilicantiy Irom 0.3 ng/mg (range 0.03 lo 13.5) during period A, lo 14.96 ng/mg (range 0.26 to 25.00) during period B, decreasing to 7.88 (range 0.77 lo 20.70), but not signilicanlly, during lhe use 01 indomelhacin. The proslaglandin leveis were not related lo calciuria during the 3 study periods. This sludy demonslrales Ihat, urinary PGE2 and PGM; calciuria; Iraclional excrelion 01 sodium increase during immobilizalion; however Ihese data do nol support a direct causalive relalionship between urinary PGE2, PGEM and calciuria

Neutrophils phagocytosing fungal hyphae in urinary sediment

The Phagocytosis of fungal structures by neutrophils is a well-documented function of these immune cells. However, neutrophil phagocytosis of hyphal structures in the urine sediment is not usually observed during routine sample evaluation. This is a case of hyphal phagocytosis by neutrophils in the urine of a kidney allograft recipient patient.A fagocitose de estruturas fúngicas por neutrófilos é uma função bem documentada destas células imunes. No entanto, a fagocitose de hifas por neutrófilos no sedimento urinário não é normalmente observada durante avaliação de rotina de amostras. Este é um caso de fagocitose de hifas por neutrófilos na urina de um paciente receptor de aloenxerto renal

Peritonitis by Scedosporium apiospermum in a patient undergoing continuous ambulatory peritoneal dialysis

É relatado caso de peritonite por Scedosporium apiospermum em menino sob diálise peritoneal ambulatorial continuada. O achado de formas teciduais sugestivas do fungo acelerou o diagnóstico da infecção.A case of peritonitis due to Scedosporium apiospermum in a boy undergoing continuous ambulatory peritoneal dialysis is reported. The finding of suggestive tissual form of the fungus in the effluent hastened the diagnosis of the infection

Peritonitis by Scedosporium apiospermum in a patient undergoing continuous ambulatory peritoneal dialysis

É relatado caso de peritonite por Scedosporium apiospermum em menino sob diálise peritoneal ambulatorial continuada. O achado de formas teciduais sugestivas do fungo acelerou o diagnóstico da infecção.A case of peritonitis due to Scedosporium apiospermum in a boy undergoing continuous ambulatory peritoneal dialysis is reported. The finding of suggestive tissual form of the fungus in the effluent hastened the diagnosis of the infection

Reduced peripheral and respiratory muscle strength in pediatric patients after kidney transplantation

Abstract Introduction: Reduced muscle strength and low-exercise capacity are well documented in adults, but there are few studies examining those impairments in children and adolescents after kidney transplantation. The objective of this study was to evaluate peripheral and respiratory muscle strength and the association with submaximal exercise capacity in children and adolescents after kidney transplant. Methods: Forty-seven patients between six and 18 years of age clinically stable after transplantation were included. Peripheral muscle strength (isokinetic and hand-grip dynamometry), respiratory muscle strength (maximal inspiratory and expiratory pressure), and submaximal exercise capacity (six-minute walk test – 6MWT) were assessed. Results: Patients had a mean age of 13.1 ± 2.7 years and an average of 34 months had elapsed since the transplantation. Flexors of the knee showed a significant reduction in muscle strength (77.3% of predicted) and knee extensors had normal values (105.4% of predicted). Hand-grip strength and maximal respiratory pressures (inspiratory and expiratory) also were significantly lower than expected (p < 0.001). Although distance walked in the 6MWT was significantly lower than predicted (p < 0.001), no significant correlation was found with peripheral and respiratory muscle strength. Conclusion: Children and adolescents after kidney transplantation have reduced peripheral muscle strength of knee flexors, hand-grip, and maximal respiratory pressures. No associations were found between peripheral and respiratory muscle strength and submaximal exercise capacity